Αntyllus, one of antiquity’s most skilled and innovative surgeons, was an ancient Greek physician active in Rome around 150 AD. Though influenced by earlier Greek medical traditions, he broke from the conservative models of physicians such as Hippocrates and Galen and introduced practical surgical procedures, especially for vascular conditions. These shaped medicine for centuries.
Antyllus is best known for designing the first effective surgical treatment for aneurysms. While earlier physicians feared vascular surgery, Antyllus embraced it with precision.
He classified aneurysms into traumatic and spontaneous types. His method involved tying off the artery both above and below the swollen vessel. Then, he excised the aneurysmal sac.
This direct approach represented a major advancement. It became the standard procedure for aneurysm treatment and remained in use until the 19th century. Unlike Galen, who emphasized theory, Antyllus prioritized anatomical understanding through practice. He accepted surgical risks others avoided, setting the foundation for vascular surgery.
Antyllus’s contributions extended beyond arteries. He developed surgical techniques for the abdomen, eyes, bones, joints, and breasts. He was also a pioneer in plastic surgery.
His reconstructive operations addressed eyelids, ears, noses, and cheeks. In trauma cases or for cosmetic repair, no one could match his precision.
To control bleeding during operations, Antyllus used cauterization. He also performed early tracheotomies, a high-risk but potentially life-saving procedure.
Oribasius, a later Greek physician, reported that Αntyllus wouldn’t operate on exceptionally large aneurysms due to high risk. For more manageable aneurysms in the limbs and head, Antyllus applied ligatures to the arteries entering and leaving the aneurysm. He then incised the sac, evacuated its contents, and packed the cavity.
Most importantly, Antyllus did not resect the aneurysm sac. He warned against excising the dilated section between ligatures, stating:
“Those who tie the artery, as I advise, at each extremity, but amputate the intervening dilated part, perform a dangerous operation. The violent tension of the arterial pneuma often displaces the ligatures.”
Oribasius also preserved one of the earliest known classifications of aneurysms into true and false types. Specifically, he said:
“There are two types of aneurysms: the first is due to dilatation of the arteries and the second is caused by rupture of the artery emptying blood into the tissues. When an aneurysm is due to dilatation, the form is cylindrical, while the one caused by injury is round.”
Aetius of Amida was a 7th century physician. In his work “On the Dilatation of the Vessels,” he described in detail a surgery likely based on Antyllus’ method:
“An aneurysm located in the bend of the elbow is treated thus. First we carefully trace the artery leading to it, from armpit to elbow, along the inside of the upper arm. Then we make an incision on the inside of the arm, three or four finger-breadths below the armpit, where the artery is felt most easily. We gradually expose the blood vessel and, when it can be lifted free with a hook, we tie it off with two firm ligatures and divide it between them. We fill the wound with incense and lint dressing, then apply a bandage. Next we open the aneurysm itself and no longer need fear bleeding. We remove the blood clots present, and seek the artery which brought the blood. Once found, it is lifted free with the hook, and tied as before.”
Antyllus believed health required daily effort and discipline. He championed preventative medicine alongside surgical skill. For instance, he prescribed exercise regimens that included structured vocal routines. One of his most distinctive practices was vociferation, a method of controlled, loud vocalizing.
He recommended reciting memorized poetry at various volumes while walking and believed deep tones helped expand the trachea and chest, strengthening respiratory health. This practice combined breath control, posture, and movement in a holistic approach to physical well-being.
Before such vocal workouts, Antyllus suggested preparation consisting of massage, bowel evacuation, and a cold sponge bath. These details reflected his methodical attention to physiology.
While Hippocrates emphasized prognosis and symptom observation, he likely saw aneurysms but avoided surgical intervention. Moreover, Galen offered greater anatomical theory, drawn from animal dissection but still steered clear of artery operations.
Antyllus surpassed both in operative practice. Whereas Hippocrates and Galen used caution, Antyllus applied bold innovation grounded in anatomy. His hands-on techniques proved enduring. Byzantine and Islamic medical texts preserved his methods, which reached medieval Europe through translation.
Despite the historical focus on Hippocrates and Galen, Αntyllus, the Greek physician, remains a towering figure in the evolution of medicine, uniting theory with surgical practice. His aneurysm procedure became standard practice for over 1,500 years. Antyllus developed detailed and replicable techniques in plastic and general surgery.
Αntyllus’s advocacy for preventative care—including vocal and physical training—also marks him as an early holistic health thinker. To say the least, he deserves recognition as the first true vascular surgeon of antiquity, as his skill, anatomical knowledge, and forward-thinking philosophy left a lasting imprint on medical history.
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